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(Chest. 1999;115:1214.)
© 1999 American College of Chest Physicians

Temporary Pacing After Pneumonectomy

Alan S. Coulson, MD, FCCP

To the Editor:

I greatly enjoyed the very valuable review article, "The Postpneumonectomy State" by Kopec and colleagues.1

I noted that in the section on cardiovascular complications, the authors referred to the risk of hypotension and bradycardia as a result of the medical treatment of arrhythmias following pneumonectomy. For the last several years, I have been suturing temporary atrial and ventricular pacemaker wires on the surface of the heart after pneumonectomy to help in the management of postoperative arrhythmias. The wires can be used to help in the diagnosis of complex arrhythmias, and they can be used for overdrive pacing in the routine treatment of bradyarrhythmias. They are easily removed when they are no longer needed.

Correspondence to: Alan S. Coulson, MD, FCCP, Linacia Building, 420 West Acacia Street, Suite 12, Stockton, CA 95203

References

  1. Kopec, SE, Irwin, RS, Umali-Torres, CB, et al (1998) The postpneumonectomy state. Chest 114,1158-1184[Free Full Text]

Temporary Pacing After Pneumonectomy

Scott E. Kopec, MD*; Richard S. Irwin, MD, FCCP* and A. Alan Conlan, MD, FCCP*

University of Massachusetts Medical School Worcester, MA

To the Editor:

We greatly appreciate Dr. Coulson's kind remarks concerning our review. The section of our review article1-1 that Dr. Coulson is referring to has to do with the use of different medications to prevent arrhythmias after pneumonectomy. Studies examining the use of prophylactic treatment to prevent arrhythmias after pneumonectomy have failed to demonstrate any clear beneficial agent. Specifically, we mentioned a prospective study comparing verapamil and placebo.1-2 The patients receiving verapamil had no significant decrease in developing arrhythmias compared to the group receiving a placebo, but had a 9% and 14% incidence of bradycardia and hypotension, respectively. Two prospective studies suggest that diltiazem1-3 or flecainide1-4 may be beneficial, but both studies contained too small number of patients to be definitive.

Dr. Coulson suggests the routine use of pacemaker wires to treat arrhythmias once they occur after pneumonectomy. To our knowledge, there are no studies in which temporary cardiac pacemaker wires were prophylactically placed at the time of pneumonectomy, as suggested by Dr. Coulson, although it is a common practice after cardiac surgery. Since this procedure is most expeditiously performed in patients undergoing intrapericardial pneumonectomy, it is not clear if it should be routinely performed in other types of pneumonectomy, except perhaps in patients at high risk for developing postoperative arrhythmias. Nevertheless, given the high mortality associated with developing arrhythmias after pneumonectomy and the potential side effects of medications used to treat the arrhythmias, Dr. Coulson's idea merits further study.

Correspondence to: Scott E. Kopec, MD, University of Massachusetts, Department of Medicine, 55 Lake Avenue North, Worchester, MA 01655-0330; e-mail: scott.kopec@banyan.ummed.edu

References

  1. Kopec, SE, Irwin, RS, Umali-Torres, CB, et al (1998) The postpneumonectomy state. Chest 114,1158-1184
  2. Van Miegham, W, Tits, G, Demuynck, K, et al (1996) Verapamil as prophylactic treatment for atrial fibrillation after lung surgery. Ann Thorac Surg 61,1083-1086[Abstract/Free Full Text]
  3. Amar, D, Roistacher, N, Burt, ME, et al (1997) Effects of diltiazem versus digoxin on dysrhythmias and cardiac function after pneumonectomy. Ann Thorac Surg 63,1374-1382[Abstract/Free Full Text]
  4. Borgeat, A, Biollaz, J, Bayer-Berger, M, et al (1989) Prevention of arrhythmias by flecainide after noncardiac thoracic surgery. Ann Thorac Surg 48,232-234[Abstract]




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